S9125 HCPCS Code: Respite care (Units, EVV, Rates, Denials)
S9125: Respite care, in the home, per diem. Billing unit, which services it covers, modifiers, whether EVV applies, typical rate notes by state and the common denial reasons.
S9125 is “Respite care, in the home, per diem.” It is billed per day and covers a day of in-home respite that gives the family caregiver a break. Medicare does not pay it. CMS says respite that includes personal care is subject to Medicaid EVV, so check whether your state includes daily respite in its EVV program.
Units and rounding
One unit is one day. The state’s service definition sets what counts as a billable day of respite, such as a minimum number of hours. Don’t bill an hourly or 15-minute code for the same service on the same day unless the program allows it.
Modifiers you will see
- U1–U9: State-defined; often distinguish programs (waiver vs state plan), service levels or provider types
Modifier meanings are set by each state and payer, so check your provider manual. See home care billing modifiers.
Typical rates
Daily respite rates are set per state program and managed-care plan. Each state program and managed-care plan sets its own rate, so use your state’s current fee schedule.
Common denial reasons
- Days exceed the plan’s annual respite limit
- Daily and 15-minute respite billed for the same date
- Missing EVV visit, where the state requires it
- Service date outside the authorization period
Related codes
- S5150: Unskilled respite care, not hospice; per 15 minutes
- S5151: Unskilled respite care, not hospice; per diem
- T1005: Respite care services, up to 15 minutes
Source
CMS HCPCS Level II code set (quarterly update). Confirm the exact descriptor and any state-specific unit definition in your payer’s billing manual. Last reviewed November 6, 2026.
General information, not billing or legal advice. Check your state Medicaid agency’s current fee schedule and provider manual.